Claim Additional Development Requests

National Government Services will not be able to process your claim without additional documentation. The following are the most common situations when NGS would require additional documentation to process a claim:

• NOC codes or unlisted codes
• Modifier 22 – Unusual Services
• Modifier 52 – Reduced Services
• Modifier 53 – Discontinued Services
• Modifier 62 – Co-surgery
• Modifier 66 – Team Surgeons

Some claim ADRs can be responded to via NGSConnex.

Consider the Electronic Claims Attachments 275/277

• Benefits of 275 Electronic Attachment
• Benefits of 277 Electronic Attachment

An attachment, in the context of healthcare electronic data interchange, is an electronic rendition of medical documentation. An attachment can be unstructured, such as an Adobe PDF file, Word, Text or images using jpg, or tiff. The standards development organization Health Level 7 International (HL7) has developed standards for the clinical data in both types of attachments. This standard is HL7 CDA. HL7 has also developed an HL7 CDA R2 Standard Companion Guides.

Reviewed 9/26/2024